UntitledLessons from the Family Planning ProgramUntitled5:
UntitledLessons from the Family Planning Program
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The world AIDS initiative, embodied in the
UntitledUNAIDS Fund Initiative
, is perhaps the most ambitious but not the first international initiative to address perceived worldwide problems. In the past, there were efforts to fight world hunger. The world responded with the "US CARE", "Green Revolution", more recently, "Hunger Aids". And yet, hunger is still a perennial problem in many parts of the world. Now, Western scientists and companies are promising that the genetically modified plants and animals will save the world from hunger.

The World Bank, International Monetary Fund (IMF) and other regional economic development agencies were established to end "poverty" through economic development. And yet, poverty is almost endemic in many of the less developed countries (LDCs). In fact, there is increasing concentration of wealth to a few of the economic elite in many countries, while the very poor, who constitute the majority of the population, are getting poorer. The main legacies of many of these development programs are LDCs saddled with international debts; payment of the interest to the debt alone is like an albatross that hinders further economic growth. The sad fact is, the poor who benefitted the least from these economic "development initiatives", bear the brunt of the impact of huge international debt, brought about by high inflation, devaluation, unemployment, etc.

Why did many of these international programs fail to achieve their intended goals?
Drawing lessons learned from these previous international initiatives, including their failures, would provide fresh perspectives to help increase the success of the world AIDS initiative.

Closest among these previous international initiatives is the worldwide family planning program; launched in the late 1960's, during a time when "population explosion" was considered the most pressing problem in the world. Like the ambitious world AIDS initiative, currently planned, the previous worldwide "family planning" program attempted to modify human behavior and sexuality to control world population growth.

During the early stages of the worldwide "population control" campaigns, there were attempts to provide free or subsidized supplies of condoms, pills, IUDs, etc. to people in less developed countries (LDCs). It must have dawned eventually among the "brains" behind the worldwide "population control" program that there was just not enough foreign aid funds from Western countries to subsidize the condoms or pills needed by the poor in less developed countries (LDCs).

Without foreign subsidy, the poor in less developed countries (LDCs) just did not have the money to buy the condoms, pills, IUDs, etc. -- to avoid the next "unwanted child". There were of course, other cultural or even religious barriers, why the pill or the condom just did not become popular in many of the less developed countries (LDCs).

The birth rates (and unfortunately also the death rates) continue to be highest among the poorest countries in the world. Several decade after the international family planning program was launched, populations of countries, especially coming from the poorest countries, continue to grow. The world population growth is predicted to continue increasing before it begins to level off during the next century.

Short of the draconian "China solution", Western approaches to population control just did not and would not work in less developed countries (LDCs). Cultural, religious and economic factors served as barriers to acceptance of Western approaches to population control in LDCs.

The world AIDS initiative would suffer similar setbacks, if current policy makers in the AIDS initiative do not learn from the "failures" of the previous international initiatives, like the family planning program.

Ironically, until a vaccine can be deviced against HIV, condom use may be one of the few realistic approaches to help curb HIV infection. Unfortunately, condom use did not gain universal acceptance even after decades of indoctrination during the family planning campaign. What can be done and what are the chances that success in condom use will be achieved through the proposed world AIDS initiative? If there is a chance that people can be persuaded to use condom to prevent HIV infection, how much would it cost and who will shoulder the "perpetual cost" of subsidizing the condoms needed by the poor in less developed countries?

After decades of family planning control programs, why were the health care infrastructures and personnel needed to ensure the success of the family planning program still non-existent in many of the less developed countries (LDCs)? [Had these health care infrastructures and personnel been currently available, it could have been used in the planned world AIDS initiative.]

The above are just some of the many questions that should be asked in regard previous initiatives, like the family planning program. Just like in the previous family planning program, part of the problem is that, from the perspective of a "Western technocrat", the AIDS epidemic has been viewed more in terms of providing antiretroviral drugs, screening of the virus and preventive measures (e.g., condom availability, clean needles, blood screening, etc.) including education. In fact, the debate in Western media has focused so much on whether to allocate the limited resources to "prevention" or "cure" of AIDS.

Definitely, there is a need for all of the "technical" solutions, in order to stem further escalation of HIV infection. However, the root causes of the spread of the HIV in less developed countries have socio-cultural, political and economic origins. Failure to address these structural "root causes" would ultimately thwart even the most well-intentioned AIDS programs.

Harsh as it may seem, the world, no matter how well-intentioned cannot solve the problems in each country. The solutions must come from within, from among the people themselves, including the resolve to face the issue; raising the resources and mustering the manpower needed to combat the problem. This would include, most of all, addressing the root causes that have precipitated the problem. All the world can do, or must do, would be to guide and perhaps provide some help to countries that are willing to face the issue head on.

The other reality that we have to accept is that there will never be enough money from international sources to finance the needs of each country. To continue to rely on foreign aid would just spell failure in the long run. More creative approaches must be deviced to raise whatever fund that is needed, from local initiatives, to address issues like the AIDS epidemic in each country.

We go back to the "family planning" program, to end this section with a more positive note. It has been years, since the international community has abandoned its "technocratic approach" to solve the population explosion in less developed countries. Recent developments however suggest that the rate of increase of the "world population" may be tapering down.

It can be surmised that the decrease in "birth rate" came about without much reliance on Western technologies -- since contraceptives, condoms and other Western-based birth control methods are not universally used in less developed countries.
Population experts suggested that the "information campaign", as well as the increasing flow of information, through the mass media (and more recently through the internet), coupled with empowerment of women, may have contributed to the recently observed gradual deceleration in rate of increase of the "world population".

It is likely that there are many more subtle factors that contributed to the decrease in family size in some of the less developed countries. What is apparent is that the solution and the change eventually have come from within each society, albeit may have been helped by outside (foreign) initiatives.

Applying the above lessons from the "family planning" initiative to the issue at hand, the world AIDS epidemic may be fought most effectively by focusing efforts and resources on societies and perhaps even better at the community level who have the resolve to want to change their situation. For example, in the case of South Africa, the national leaders are bent on opposing most AIDS initiatives. To address this constraint, the international community may focus instead in identifying "legitimate" and instituting AIDS initiative directly through local NGOs who are willing to devote resources and manpower to combat AIDS in their community.

International organizations, like "Medecins Sans Frontieres (MSF)", may help provide technical and biomedical expertise to help these local NGOs to set up local infrastructures and develop a cadre of "local medical providers" who will then do most of the work to institute the "AIDS inititiative". The focus must be towards long-term local "self-sufficiency" with just minimal help from foreign sources of funds.

The approach presented above is radically different from the proposed "UNAIDS initiative" which intends to apportion its very limited resources based mainly on the numerical number of people living with HIV/AIDS in each country.

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